Contract Pharmacy Details

WALGREENS SPECIALTY PHARMACY, LLC
CH034100 PORTSMOUTH COMMUNITY HEALTH CENTER, INC.,d/b/a Hampton Roads Community Health Center

Covered Entity Details

Entity Name

PORTSMOUTH COMMUNITY HEALTH CENTER, INC.,d/b/a Hampton Roads Community Health Center

Subdivision Name

PORTSMOUTH COMMUNITY HEALTH CENTER, INC.

Type

HRSA-Funded Health Center

340B ID

CH034100

Entity Address

664 Lincoln St
Portsmouth, VA 23704-4818

Grant Number

H80CS00729

Participating Start Date

1/1/1994

Last Recertification Date

1/31/2023

Entity Termination Date

1/1/2024

Pharmacy Details

Pharmacy Name

WALGREENS SPECIALTY PHARMACY, LLC

Pharmacy Address

DBA WALGREENS SPECIALTY PHARMACY #15438
41460 HAGGERTY CIR S
CANTON, MI 48188

Pharmacy Comments

Contract Details

Approval Date

10/9/2019

Contract Begin Date

1/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Barbara Willis, CEO
(757) 393-6363

Contract Pharmacy Representative

Walgreens
Aliena Jaffri, 340b Client Relationship Analyst
(847) 964-6103

Signed By Date

10/9/2019

340B Drug Pricing Program Database